膝单髁置换术中胫骨平台后倾角测量和定位方法的研究进展

Research progress on the measurement and positioning method of tibial platform camber angle in unicompartmental knee arthroplasty

目的总结膝单髁置换术(UKA)中胫骨平台后倾角(PTS)的测量及定位方法的研究进展。方法在中国知网、万方数据、PubMed等数据库, 以"膝关节单髁置换术""胫骨平台后倾角"以及"unicompartmental knee arthroplasty""posterior tibial slope"等为中、英文关键词, 检索2017年1月—2023年7月发表的相关文献共87篇, 剔除其中内容不符、质量较低、重复研究、证据等级不高、无法获取全文者, 最终纳入37篇文献, 对PTS在UKA术中的意义、PTS测量及其术中定位方法的相关研究成果进行归纳总结。结果在UKA术中获得良好的PTS对患者术后膝关节软组织平衡、关节活动度的恢复具有较大意义。MRI和CT是测量PTS最为准确的方式, 而基于X线片的胫骨近端解剖轴(TPAA)参照法、前皮质切线(ATC)参照法和后皮质切线参照法由于经济便捷在临床使用更多, 其中TPAA参照法最佳, 可作为统一的测量方法, ATC法可作为随访及髓外引导时的首选方法。传统UKA术中PTS定位多依靠髓外定位杆进行经验测量, 但准确性较低。其改进方法, 如新型截骨导向杆参照法、前内侧胫骨平台参照法及探针法等, 有效提高了术中PTS定位的精准性;另外, 数字骨科技术如增强现实技术、计算机导航、机器人辅助及个性化截骨导板等, 也能提高PTS定位准确性, 是未来精准医疗的方向。结论在UKA术中恢复患者原始PTS具有重要意义。通过术前精准测量与定位、术中应用先进方法进行截骨, 能够有效提高手术精确性与临床效果。

Objective This study aimed to summarize the research progress on the measurement and positioning of tibial platform tilt angle(PTS)in unicompartmental knee arthroplasty(UKA).Methods In the present study,in PubMed and other databases of CNKI,"膝关节单髁置换术""胫骨平台后倾角"and"unicompartmental knee arthroplasty""posterior tibial slope"are used as Chinese and English keywords.A total of 87 relevant literatures published from January 2017 to July 2023 are included.Those whose content is inconsistent,the quality is low,the duplicate research evidence is not high,and the full text cannot be obtained are excluded and 37 literatures are searched and finally included to summarize the significance of PTS in UKA and the relevant research results on the measurement of PTS and intraoperative localization methods.Results It was important to obtain good PTS during UKA surgery for soft tissue balance and range of motion of the knee.MRI and CT are the most accurate methods used to measure PTS.X-ray-based tibial proximal anatomical axis(TPAA)reference method,anterior tibial cortex(ATC)reference method,and posterior tibial cortex reference method are economical and convenient to use.TPAA can be best used as a unified measurement method,and ATC is the preferred method for follow-up and extramedullary guidance.Traditional UKA intraoperative PTS mostly relies on extramedullary positioning rods for empirical measurement,but the accuracy is low.Improved methods such as new osteotomy guide rod reference method,anteromedial tibial platform reference method,and probe method effectively improve the accuracy of intraoperative PTS positioning.Digital orthopedic technologies such as augmented reality technology,computer navigation,robot assistance and patient specific instrumentation osteotomy guide plate can also improve the positioning accuracy of PTS,which is the direction of precision medicine in the future.Conclusion Restoring the original PTS in patients during UKA surgery is of great significance.The application of advanced methods for osteotomy can effectively improve the accuracy and clinical effect of surgery through accurate preoperative measurement and positioning method.